Szaflarski Jerzy P, Page Stephen J, Kissela Brett M, Lee Jing-Huei, Levine Peter, Strakowski Stephen M
Department of Neurology, University of Cincinnati Medical Center, OH 45267, USA.
Arch Phys Med Rehabil. 2006 Aug;87(8):1052-8. doi: 10.1016/j.apmr.2006.04.018.
To determine whether cortical changes occur following participation in a program of modified constraint-induced movement therapy (mCIMT).
Pre-post, case series.
Outpatient rehabilitation hospital.
Two men and 2 women with unilateral stroke occurring more than 1 year prior to study entry and moderate stable motor deficits.
Subjects participated in mCIMT, comprised of structured, 30-minute therapy sessions emphasizing affected arm use in valued activities, which occurred 3 days a week for 10 weeks. Their unaffected arms were restrained 5 days a week for 5 hours.
The Action Research Arm Test (ARAT), upper-extremity portion of the Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and functional magnetic resonance imaging (fMRI) at 4T were administered before and after mCIMT.
Three subjects exhibited score increases on the MAL, ARAT, and FMA, representing increased affected arm use, impairment, and function. These subjects reported new ability to perform valued activities with the affected hand, such as writing. These subjects also displayed cortical reorganization on fMRI. One subject exhibited minimal affected arm use changes, modest function changes, and no cortical fMRI changes.
Increased affected arm use during mCIMT appears to induce cortical reorganization, as measured by fMRI. In patients who responded to mCIMT, cortical reorganization was positively related to degree of increase in affected arm use and ability. Because mCIMT is more easily administered than longer duration protocols, mCIMT may be a more practicable way of studying plasticity.
确定参与改良强制性运动疗法（mCIMT）项目后是否会发生皮质变化。
前后对照病例系列研究。
门诊康复医院。
两名男性和两名女性，均为单侧脑卒中患者，发病时间距研究开始超过1年，且存在中度稳定的运动功能缺损。
受试者参与mCIMT，包括每周3天、为期10周、每次30分钟的结构化治疗课程，重点是在有意义的活动中使用患侧上肢。他们的健侧上肢每周限制使用5天，每次5小时。
在mCIMT前后分别进行动作研究上肢测试（ARAT）、Fugl-Meyer评估（FMA）上肢部分、运动活动日志（MAL）以及4T功能磁共振成像（fMRI）检查。
三名受试者在MAL、ARAT和FMA上的得分有所提高，表明患侧上肢的使用增加、功能缺损改善以及功能增强。这些受试者报告称患手有了进行如书写等有意义活动的新能力。这些受试者在fMRI上也显示出皮质重组。一名受试者患侧上肢的使用变化极小，功能有适度改变，且fMRI未显示皮质变化。
通过fMRI测量发现，mCIMT期间患侧上肢使用增加似乎会诱发皮质重组。在对mCIMT有反应的患者中，皮质重组与患侧上肢使用增加的程度和能力呈正相关。由于mCIMT比持续时间更长的方案更易于实施，mCIMT可能是一种更可行的研究可塑性的方法。
